A little disconcerting, eh? Now there are obviously a lot of surgeries taking place every day in the US, so on a percentage basis having just 20 procedure in which the surgeon operates on the wrong site is very low. Still, that is not very helpful t the person who has a stitches on the wrong side of their body.

Like this:

Much of operations is about standardization. There is much to be gained from building processes that are appropriately tailored to the task at hand and handling that task in the same “best” way every time. And then there is health care, where every patient is unique in some way and doing less is seen as an anathema. There is a very real possibility that not opting not to do some test or some procedure could lead to adverse outcomes for patients. However, not following best practices can lead to excessive cost.

The Wall Street Journal provides a nice example from a study at a small hospital system Christiana Care that made a conscious effort to get doctors to stick established best-practice guidelines (Hospitals Cut Costs by Getting Doctors to Stick to Guidelines, Sep 22). The procedure in question is cardiac telemetry, which is a monitoring technique, and how it should be used for patients that are not in an intensive care ward.

In cardiac telemetry, electrodes are used to monitor the heart for abnormal rhythms. To try to cut inappropriate use of the monitoring at Christiana Care, which operates two hospitals, a group of physicians redesigned the electronic system that doctors use to order tests and other care.

First, they removed the option to order telemetry for conditions not included in the [American Heart Association] guidelines. Doctors could get around this and order the monitoring, but they had to take an extra step to do so, according to Robert Dressler, who helped lead the study. “We didn’t want to get in the way of the bedside clinician who had a demonstrable concern” and wanted to use telemetry despite contradicting guidelines, he said.

Share this post:

Like this:

For all the faults of its roll out, the Affordable Care Act should ultimately provide more people with health insurance and thus a way to pay for basic health care. That implicitly assumes that there is enough health-care capacity to go around. There is a very real concern that there is not enough capacity — particularly in primary care — to properly cope with an influx of newly insured patients who will want to do basic things like see a doctor.

Cooper University Hospital is expecting a huge wave of patients starting next month, as millions of consumers get health insurance, some for the first time. The question for hospital executives in Camden, and around the country, is how to manage this new population. For one, there is a chance this new patient population will exacerbate existing problems at Cooper.

The Urban Health Institute serves more than 8,000 patients, virtually all of them low-income. Vogan says the poorer the patients, the more likely they’ll miss their appointments. And that’s an expensive problem. But Vogan says the solution is simple.

“If not all of your patients show up then the easiest thing to do is, well, just book more of them,” he says.

It is hard to think of a more challenging problem: How do you distribute necessary medicines in a developing country lacking infrastructure? That is question tackled by Simon and Jane Berry, two Brits trying to reduce childhood deaths from diarrhea in Africa. Diarrhea is the leading cause of death for children under five — which is tragic since it is not some mysterious disease. It is completely treatable by standard and (in the grand scheme of things) cheap medicines. But you need to get the medicines out to rural areas. The Berry’s solution was a packaging innovation that lets them piggyback on existing, super efficient supply chain. Whose supply chain? Here’s a hint, their not-for-profit is called ColaLife (ColaLife: Turning profits into healthy babies, BBC, Jul 22).

Simon Berry and his wife Jane had come up with a strikingly-simple idea – a package for medicine that slotted into the empty space at the top of a crate of soft drink bottles, fitting neatly in between the bottlenecks.

A dazzling idea, to piggyback the delivery of the diarrhoea medicine for babies onto one of the most efficient distribution systems in the world. Go anywhere and you will find a shop selling Coca-Cola. And the plastic packaging is ingenious – once opened it becomes a measuring device.

Here is what ColaLife’s anti-diarrheal kits look like sitting in the crates.

It’s been a bad flu season with hospitals in many cities overwhelmed with patients. This is largely a preventable problem. The annual flu vaccine is not perfect but a wider use of the vaccine would provide some amelioration. So why don’t more people get a flu shot? Some reporter at the LA Times seemed to think that cost might be a factor (Why does a flu shot cost so much?, Jan 21). After all, getting the shot at your local pharmacy will set you back $30 or so. However, as the reporter found out, given the supply chain challenges of producing and distributing influenza vaccines, the real question is why flu shots cost so little.

That’s because the process of manufacturing the flu shot and distributing it is a huge headache for pharmaceutical companies. The influenza vaccine must be made anew each year, beginning in February. Researchers determine what strains to put in the vaccine after looking closely at what types of flu are most prevalent in the Southern Hemisphere throughout its winter, which is our summer. …

Vaccines for other illnesses, such as measles, mumps and rubella, can be used until their expiration date, which is often years after they’re made. Influenza vaccines are really only used September through January and then go in the trash. And there are no regulations saying people have to get flu vaccines, meaning it’s very difficult for companies to estimate how many they should make. …

This year, companies have produced about 145 million doses, he said. Only about 129 million have been distributed. Last year, companies lost even more on the flu vaccine because it was such a light flu season and fewer people decided to get the shot. Only about 42% of the U.S. population got an influenza vaccine last year, which meant that about 30 million doses were never used and had to be destroyed.

Like this:

Over the years, we have had several posts applying lean operations to health care (see, for example, this or that). However, we have yet (I think) to post anything on Virginia Mason. Despite what its name might suggest, Virginia Mason is located in Seattle and has long been known as a leader in taking lessons from Toyota and applying them to health care. Now, in the form of a report from PBS’s NewsHour, we have an excuse to remedy that oversight (Rooting Out Waste in Health Care by Taking Cue From Toyota Assembly Lines, Oct 24). Check it out!

Last year, 4,720 people died while waiting for kidney transplants in the United States. And yet, as in each of the last five years, more than 2,600 kidneys were recovered from deceased donors and then discarded without being transplanted, government data show.

The question is why. One may conclude that the system is just inefficient, yet a closer look reveals that this inefficiency is rooted in many important principles, regulations, and incentives, all while attempting to create a fair system. In order to better understand the issues, we need to understand how kidneys are being allocated in the US: The country is divided into 58 districts. When a kidney of a deceased person becomes available, the system allocates it to the person with the highest priority within that region. This priority is a function of the waiting time, whether a recipient is a child or not, as well as other factors. The system does not consider the projected life expectancy of the recipient or the urgency of the transplant. The allocation is initially local, and only when there is no match, the search expands to other regions. All of that is done while competing against the clock: Kidneys start to degrade after 24-36 hours. The system is allowed to make offers to only a limited set of hospitals at any point in time, and these, in turn, have an hour to respond.